The home health care services industry had its share of problems before the coronavirus pandemic. Now things are even worse. Patients worried about COVID-19 are canceling appointments, home care workers are anxious about contracting the virus themselves and many lack access to personal protective equipment.
Since the industry already operated on thin margins, said William Dombi of the National Association for Home Care and Hospice (NAHC), large as well as small providers of home health services are feeling the pain. “This is a serious problem,” Dombi told USA Today. “Home care, as a resource during the crisis, could fall apart because it’s losing revenue.”
An estimated 10 to 12 million Americans depend on home care workers for everything from wound care and physical therapy to help with daily living tasks like getting dressed, eating meals and going to the bathroom. And the demand for their services is growing. According to PHI, a nonprofit that advocates for direct care workers, the population of Americans aged 65 and older is expected to nearly double by 2050, from 47.8 million (in 2015) to 88 million.
The Bureau of Labor Statistics classifies home health workers under the Health Care and Social Assistance sector of the Education and Health Services supersector. Health Care and Social Assistance itself has four subsectors, including Ambulatory Health Care Services. The ambulatory subsector is divided further into multiple industry groups, including Home Health Care Services.
Job titles under Home Health Care Services include in-home caregiver, home health aide, home care aide, certified home health aide and certified nurse’s aide. Among services provided in the niche field are in-home physical therapy, counseling, dietary and nutritional services and high-tech therapy like IV care. These services are provided not only in patients’ homes but at retirement facilities and assisted living facilities and through hospice providers.
There were 3.25 million jobs in the home health and personal care industry in 2018 – 2.4 million of them classified as personal care aides, and the remainder (831,800) home health aides. Metros with the highest total employment in the field were New York-Newark-Jersey City, NY-NJ-PA (with 404,750 workers) and Los Angeles-Long Beach-Anaheim, CA (with 252, 950). The metro with the highest employment concentration for the field was Brownsville-Harlingen, TX, which had more than six times the concentration of these roles than the average U.S. metro.
Salary and Turnover Issues
Even before COVID-19, the industry was grappling with long waiting lists for its services, along with a shortage of workers, especially in rural areas. Pay for these workers is notoriously low. The mean hourly wage for the industry in 2018 was $12.71, and it can be even lower for personal care aides.
Women make up 89% of home health care workers, according to PHI. The nonprofit also states that one in every two direct care workers leaves her job within 12 months, often citing low wages as the main reason. Between 2018 and 2028, there will be 8.2 million direct care job openings that will need to be filled, according to PHI. That includes 1.3 million new jobs, plus 6.9 million positions that will become vacant as existing workers exit the industry.
No doubt, home health care workers are feeling the strain of the pandemic. In April alone, the industry lost more than 93,000 jobs. Dombi of the NAHC says tens of thousands of home care appointments have been canceled by anxious patients who are unwilling to let workers into their homes. The Homecare Association of New York State says nearly 70% of its providers did not have access to adequate personal protective equipment.
And home health workers like Nemo Yusuf, a personal care provider, are worried about the financial devastation they would suffer – and the impact of their absence on their clients – if they came down with COVID-19. “It’s really scary,” she told USA Today.
Meantime, though, some home-based care providers see a silver lining in the pandemic, as many senior living and skilled nursing facilities that face staffing shortages turn to home care providers that have staffing divisions. These divisions are providing those facilities with additional home health aides and certified nurse’s aides.
At the same time, the NAHC contends that “the home health care sector is ideally suited to reduce the burden on our nation’s hospitals in this time of crisis.” That’s because home care workers can help hospitals and health care facilities free up capacity to treat COVID-19 patients by safely caring for discharged patients with chronic illnesses – and those patients being “investigated” for COVID-19 – in their homes.
To do that most efficiently, the NAHC says more PPE must be made available, residential and care facilities should allow access to more home care specialists and regulatory barriers should be lifted to allow for “alternative delivery models,” such as telephonic and videoconferencing visits, when in-person care is not possible.
If it’s able to confront and overcome its current problems, it’s safe to say the home health care industry will provide opportunities for entry-level workers with a compassionate bent for years to come.
ThinkWhy continuously monitors and forecasts industries and MSAs to measure the impact on the labor market. Stay current with us. We are here to support organizations and provide insights during the economic downturn as well as the recovery phase.